Dr. Chandra Speight knew early on that she had a mission to make North Carolina a better place, but it took her a few degrees and a little life experience to discover her true goal: reducing the devastating harms of addiction, especially for mothers in rural and underserved areas of the state.
Speight, an assistant professor in the School of Nursing’s Department of Advanced Nursing Practice and Education, grew up in Greensboro but her family is from eastern N.C. She made the journey north after earning a bachelor’s degree in English from East Carolina University, where she was awarded the Chancellor’s Award of Excellence.
After earning a master’s degree in political science from Pennsylvania State University, she began working as a consultant on women’s health policy for the United States Agency for International Development in Washington, DC.
Her time with the federal government was short, but the experience planted a seed: She returned to Greenville to teach political science at ECU, and because one of the perks of being employed by a university is the ability to take classes for free, she went on to a second master’s in English, which she completed and taught in the English department.
Dr. Chandra Speight, assistant professor of nursing, previously taught political science and English at ECU.
Her background in political science and experience working with solutions at US AID led her to pursue a degree in nursing education so that her abiding interest in health policy could shift from thinking about and teaching about public policy to being an agent of change rather than a bystander.
So she quit teaching and went back to school.
“My plan was to become a nurse, a nurse practitioner, and then get a doctorate in nursing and study health policy,” Speight said. “I knew nurse practitioners were key to providing health care in rural areas, so I knew I wanted to be a nurse practitioner even before I started my studies.”
Over time, Speight’s interests narrowed: how advanced practice nurses can alleviate the challenges of rural health care, specifically how addiction affects individuals and how that impacts the community.
“I began to understand that the opioid crisis is the biggest health care access crisis facing the United States, and especially here in eastern North Carolina, so I shifted my research focus to the area of opioids, substance use disorders and how nurses can impact that,” Speight said.
Speight was troubled by the disconnect between nurses playing a large role in rural health care delivery, as is the case in eastern North Carolina, and the federal government restricting nurse practitioners from prescribing suboxone, a powerful medication that helps opioid users reduce their addiction.
In 2016, this restriction was lifted, allowing NPs to finally prescribe suboxone, which is effective in reducing overall mortality by 50% in people with opioid use disorder.
“It’s unprecedented. There’s no drug that’s as effective,” Speight said.
Knowing that effective use of treatment options can reduce addiction, she directed her research and service efforts toward understanding the barriers nurses face in treating substance use disorders, and she wanted to know how to translate that research into effective and effective educational programs for other health care professionals, particularly advanced practice nurses (APRNs).
Speight is collaborating with colleagues in nursing and allied health sciences, as well as local clinical partners, to form an interdisciplinary team to study and address substance abuse head-on in Eastern North Carolina.
She and her team have secured hundreds of thousands of dollars in grants and are seeking larger grants to expand their research into nontraditional clinical spaces, such as centers that provide meals to food insecure people and the few needle exchange programs in rural eastern North Carolina.
One of the team’s goals is to establish a perinatal substance use disorder clinic, as the Eastern Region is the only region in the state without dedicated clinical resources to help mothers reduce or stop substance abuse before and within a year of giving birth.
“Many women, or pregnant women, try to reduce their drug use during pregnancy, but after giving birth they often lose that motivation, get stressed, go back to using drugs and lose their tolerance,” Speight said.
Speight’s research and clinical experience have taught her that problems don’t seek out her to find solutions — she has to go where the need is, often in her own neighborhood.
“Eastern North Carolina has some of the worst opioid and drug-related death rates in the country. In Craven County, where I live, the overdose death rate is more than double the North Carolina average, and roughly 40 percent of children in foster care are in foster care because a parent has a substance use disorder,” Speight said.
Speight said North Carolina’s maternal health statistics are dire, with recent studies showing that nearly half of maternal deaths are due to overdose, most of which are due to opioid abuse.
“A key principle of harm reduction is that we find out where people are and help them set goals. Their goal might be to get treatment or it might be to continue using. If they choose to continue using, we help them understand how to use more safely, with the goal of protecting people’s lives,” Speight said.
Part of the solution Speight hopes to achieve through grant funding he has won and the educational and clinical partnerships he has fostered is to build a sustainable framework that will attract like-minded students to learn how to pass the baton to the next generation of harm reduction care in rural areas of the state.
The combination of underfunded drug treatment networks and stigma-ridden populations makes it difficult to teach students how to broach the taboo topic of addiction with patients, but Speight believes ECU and community partners are finding ways to teach future nurses to overcome their own biases and prejudices so they can best serve the people who rely on their care.
“When we look at the opioid crisis in eastern North Carolina, we see a shortage of prescribers. We have to create our own solution to this problem,” Speight said. “We have the dental school, the medical school, all the APRN programs. We also have the only midwifery program in North Carolina, South Carolina and Virginia. We are really here to create this workforce.”
Speight said he sees a growing workforce among the students he teaches and mentors and that’s one ray of light in the dark horizon for harm reduction care in coastal North Carolina.
“It’s so rewarding to hear from students who are working in the community testing and treating substance use disorders that they enjoy their work and find it rewarding,” Speight said. “They teach the physicians and NPs they work with and help break down barriers because it saves lives.”
Fast Facts
name: Dr. Chandra Speight
title: Assistant Professor
home town: I live in Jamestown, North Carolina, but spent most of my childhood in eastern North Carolina with my grandmother who lived in Grifton and my maternal family who lived in Edgecombe County.
University and degree: ECU – BA English; Pennsylvania State University – MA Political Science; ECU – MA English; ECU – MSN Family Nurse Practitioner; ECU – PhD Nursing
Pirate’s Pride
Years at ECU: Total 13 students (3 from the Faculty of Nursing)
Jobs at ECU: I am an assistant professor in the Department of Advanced Nursing Practice and Education in the School of Nursing, where I teach in the Doctoral Program in Nursing Practice.
What I like about the ECU: I love the School of Nursing and its commitment to preparing pirate nurses who can provide evidence-based care in underserved areas. I strive to ensure that research is aligned with the school’s mission to be a national model for transforming health in underserved rural areas.
field of study: (Can be removed if not applicable): Rural Health Care Access, Substance Use Disorder, Opioid Use Disorder
What advice would you give to students? Words have power and can heal or destroy, so be thoughtful about the words you use to describe people and the disease processes they are experiencing.
What is your favorite class to teach? All things related to harm reduction, health policy, and medications for opioid use disorder
Quick Quiz
What do you like to do when you’re not working? Hiking the mountains of North Carolina with his family and doing crossword puzzles and other word games
Last seen on TV: The Incredibles (with kids)
First Job: Berg Teen Board
Guilty pleasures: I love premium carbonated water, the more bubbly the better!
Favorite meal: Anything my husband makes for me, he’s an amazing chef.
There’s one thing most people don’t know about me. I have served as faculty in three departments at ECU: the Department of English, the Department of Political Science, and the Department of Advanced Nursing Practice and Education in the School of Nursing.
